Trondheim Emergency Department Research Group (TEDRG), Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
Clinic of Emergency Medicine and Prehospital Care, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.
BMC Emerg Med. 2024 Jul 12;24(1):117. doi: 10.1186/s12873-024-01028-4.
Emergency department (ED) crowding is a global burden. Interventions to reduce ED utilization have been widely discussed in the literature, but previous reviews have mainly focused on specific interventions or patient groups within the EDs. The purpose of this scoping review was to identify, summarize, and categorize the various types of non-ED-based interventions designed to reduce unnecessary visits to EDs.
This scoping review followed the JBI Manual for Evidence Synthesis and the PRISMA-SCR checklist. A comprehensive structured literature search was performed in the databases MEDLINE and Embase from 2008 to March 2024. The inclusion criteria covered studies reporting on interventions outside the ED that aimed to reduce ED visits. Two reviewers independently screened the records and categorized the included articles by intervention type, location, and population.
Among the 15,324 screened records, we included 210 studies, comprising 183 intervention studies and 27 systematic reviews. In the primary studies, care coordination/case management or other care programs were the most commonly examined out of 15 different intervention categories. The majority of interventions took place in clinics or medical centers, in patients' homes, followed by hospitals and primary care settings - and targeted patients with specific medical conditions.
A large number of studies have been published investigating interventions to mitigate the influx of patients to EDs. Many of these targeted patients with specific medical conditions, frequent users and high-risk patients. Further research is needed to address other high prevalent groups in the ED - including older adults and mental health patients (who are ill but may not need the ED). There is also room for further research on new interventions to reduce ED utilization in low-acuity patients and in the general patient population.
急诊科（ED）拥堵是一个全球性问题。减少 ED 就诊量的干预措施在文献中已广泛讨论，但之前的综述主要集中在 ED 内的特定干预措施或患者群体。本综述的目的是识别、总结和分类各种旨在减少不必要 ED 就诊的非 ED 基础干预措施。
本综述遵循 JBI 证据综合手册和 PRISMA-SCR 清单。我们在 2008 年至 2024 年 3 月期间在 MEDLINE 和 Embase 数据库中进行了全面的结构化文献检索。纳入标准涵盖了报告旨在减少 ED 就诊量的 ED 以外干预措施的研究。两名审查员独立筛选记录，并按干预类型、地点和人群对纳入的文章进行分类。
在筛选出的 15324 条记录中，我们纳入了 210 项研究，包括 183 项干预研究和 27 项系统评价。在主要研究中，在 15 种不同的干预类别中，最常检查的是护理协调/病例管理或其他护理计划。大多数干预措施发生在诊所或医疗中心、患者家中，其次是医院和初级保健机构，针对的是患有特定疾病的患者。
已经发表了大量研究来调查减轻患者涌入 ED 的干预措施。其中许多研究针对患有特定疾病、频繁就诊和高风险患者的患者。需要进一步研究解决 ED 中其他高患病率群体的问题，包括老年人和精神健康患者（他们虽然生病但可能不需要 ED）。在低危患者和一般患者人群中，也有进一步研究减少 ED 利用率的新干预措施的空间。
